If A=B, and B=C, does A=C? Well, not always, but in the case of stress, racism and preterm birth, one researcher thinks there’s a definitive case to be made.

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The jarring statistics are already out there: African-American women are three to four times more likely to experience a pregnancy-related death than white women. Additionally, African-American women are nearly twice as likely to give birth prematurely as white women, which leads to low birth weight, believed to be responsible for nearly 20 percent of infant deaths. Finally, black infants are twice as likely to die as white babies in the United States.

This is true for black women and babies regardless of income, education, or pedigree—that is, a college-educated black woman is more likely to give birth prematurely than a white high school dropout.

The one thing all black women have in common is being a black woman in America; but heretofore, no one could definitively pinpoint why these disparities exist. Yet, according to the American Association for the Advancement of Science, “past research has pointed to other contributing factors to the difference, such as post-traumatic stress disorder.”

In a paper in the winter issue of the Journal of Health Disparities Research and Practice, Amelia Gavin, an associate professor in the University of Washington School of Social Work, “connects racial discrimination to PTSD, and thus to preterm birth.”

“Pregnancy is a stress test for the body. If you’ve been stressed during your life through discrimination, poverty and residential segregation, then the likelihood of having a healthy birth outcome has been compromised,” Gavin said.

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The AAAS reports:

Research over the years has examined behavioral and biological risk factors for preterm birth, including access to prenatal care, substance use and stress. PTSD, associated not only with combat experiences, but also other traumatic events such as natural disasters, assault and abuse, affects more women than men. Several studies have linked PTSD with a higher risk of preterm birth.

When broken down by race and ethnicity, PTSD affects African-Americans more than any other group, and more African-American women than men. [emphasis ours.]

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AAAS also points out that past studies have tied “the daily experiences of discrimination” to poor health, and to African-American women’s health, in particular.

“The daily experiences of discrimination, as well as the legacy of racism—neighborhoods with higher crime and fewer resources, generational poverty and limited access to health care—can lead to stress, and engagement in unhealthy behaviors,” it notes.

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Which all bolster this theory: Black women and babies are literally dying from stress.

In the University of Washington study specifically, researcher Gavin, along with co-authors Nancy Grote and Taurmini Fentress of the University of Washington School of Social Work, and Kyaien Conner of the University of South Florida, found that if discrimination is associated with PTSD, and PTSD is associated with preterm birth, then racial discrimination, via PTSD, also can be tied to preterm birth (A=C).

“I’m trying to unpack, from a life course perspective, how risk factors in black women’s lives can have an impact on the next generation,” said Gavin, who studied childhood poverty and abuse and maternal depression in graduate school, homing in on PTSD. “Exploring the mechanisms by which racial discrimination affects the next generation is really important, and that means taking into consideration maternal mental health status. When we talk about racial disparities in health outcomes, we have to think about how we construct mental health, the role of PTSD and how different racial and ethnic groups experience it.”

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Gavin says she has faced some challenges: there is a dearth of research on black women in general; on racism and how it may manifest physically and psychologically; and compounding this, that PTSD has a nebulous definition in the mental health community.

In addition to more research in this area, Gavin and her co-authors recommend health-care providers start screening all pregnant women for prenatal PTSD, in order to spot those at risk for preterm birth.

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As for eradicating systemic racism, well, that’s one for the ages—though to improve the outcome for black women and their children, the authors suggest “greater government investment in the quantity of and access to affordable housing, and in funding for K-12 education and health care,” notes AAAS.